Slides for the multi agency workshop on licensing, alcohol and health for Hertfordshire

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Licensing, Alcohol and Health
Hertfordshire Licensing Committees Public Health Seminar
3rd April 2014

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Speakers
Brian Simmonds
Head of Community Safety and
Health, East Herts Council
Brian.simmonds@eastherts.gov.uk
Jim McManus
Director of Public Health,
Hertfordshire County Council
Jim.McManus@hertfordshire.gov.uk
Dawn Morrish
Health Improvement Manager,
Community Safety and Offender
Health, Herts County Council
Dawn.Morrish@hertfordshire.gov.uk
Michael Nadasdy
Programme Officer - Anti Social
Behaviour
County Community Safety Unit
Michael.Nadasdy@hertfordshire.gov.u
k
Sarah Taylor
Programme Manager; Domestic
Violence, Stalking, Harassment, and
Hate Crime
County Community Safety Unit
sarah.taylor@hertfordshire.gov.uk
Cliff Austine
Resilience/CBRNE Support
Technician, East of England
Ambulance Service NHS Trust
Cliff.Austine@eastamb.nhs.uk

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Agenda
Introduction & Outline Brian Simmonds
• Health impacts of alcohol abuse Jim McManus
• Licensing, Health and Crime Dawn Morrish &
Michael Nadasdy
• Domestic violence Sarah Taylor
• Ambulance, first on scene Cliff Austine
• Conclusion Brian Simmonds & Jim
McManus

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Health Impacts of alcohol abuse
•Deaths related to alcohol in 2001 5,476
in 2009 6,584
•Estimated cost of alcohol harm to the NHS in
England in £2.7billion (2006-7 prices)
•In 2007 33% of men and 16% of women were
classified as hazardous drinkers

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Health Impacts of Alcohol in
Hertfordshire
Jim McManus, Director of Public Health
Licensing and Public Health Workshop
3rd April 2014

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Estimated economic costs in Hertfordshire
2008/09
£231 million
per year

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National drug treatment statistics
2012/13
Good national performance:
• 29,000 people helped to recover from addiction
• Specialist services are easy to access: 98% wait under 3 weeks;
average used to be 5 days.
Challenges:
• Ageing treatment population: over 40s are now the largest group
starting& receiving treatment
• Particularly hard to help into lasting recovery – shown by levelling off of
proportion of people successfully completing treatment
• Changing patterns in drug use incl. new psychoactive substances, and
prescription or over-the-counter medicines
http://www.nta.nhs.uk/uploads/adultstats2012-13.pdf

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Numbers in structured treatment
Q3 2013-14
Alcohol 1441 Up 18% from Q2
Opiates 1611 Up 5%
Non-opiates 803 Up 22%
Drugs total 2414
(was 2195 in 12/13)
Up 10%
(compared to -1.5%
nationally)

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Key alcohol indicators from DOMES report
Indicator Local Comparison
Clients waiting over 3
weeks to start
treatment
1.2%
(3.9% in Q2)
National: 7.1%
Successful completions
as a proportion of all
in treatment
36.1%
(was 33.1% in Q2)
National: 36.6%
Re-presentations
within 6 months
6.9%
(was 7.5% in Q2)
National: 11.2%

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Key messages
• Aging population, reflected in treatment population
• Changing landscape requires service flexibility
• Access to treatment is positive
• Need to focus on
– re-presentations particularly non-opiates
– those who are longest in treatment
–18-24 year olds

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Trends in Violent Crime in Hertfordshire 2010-2013
3
6
9
12
15
18
10-11
11-12
12-13
10-11
11-12
12-13
10-11
11-12
12-13
10-11
11-12
12-13
10-11
11-12
12-13
10-11
11-12
12-13
10-11
11-12
12-13
10-11
11-12
12-13
10-11
11-12
12-13
10-11
11-12
12-13
10-11
11-12
12-13
Hertford-
shire
Steven-
age
Brox-
bourne
Welwyn-
Hatfield
North
Herts
East
Herts
Watford Dacorum Herts-
mere
St
Albans
Three
Rivers
East& North CCG Herts Valleys CCG
ViolentCrimeIncidentsper1,000population
Violent Crime Trend
In both England and Hertfordshire the reported rates of domestic violence have not varied significantly
between 2010-13. Although East Herts has the lowest rates of domestic violence it was the only district to
show a significant increase over that period.

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Young people’s Health Related Behaviour
Survey 2012
• 67% of pupils in years 5&6 (age 9-11)had tasted
alcohol at some point
• 38% said their parents knew when they drank
• 25% of pupils in years 8&10 (ages 12-15) had
an alcoholic drink in the previous week
• 8% of pupils got drunk on at least one day in the
last week (13% year 10 pupils)

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Domains of Response
Control and
Enforcement
Prevention Treatment,
Support and
Care
Police
Probation
PCC
Licensing
Need to do better
here
Public Health
NHS
Social Care
Third Sector
Brief Interventions

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Systems thinking – Why Licensing is Important to Public Health
The wider determinants of Health and Local Government functions
(Must adopt a Lifecourse approach!)
The Lives people lead and whether LA functions help or
hinder healthy lifestyles (policy, service quality, access,
behavioural economics, behavioural sciences)
The services people access such as primary care
(high quality, easy access, good follow up,
behavioural and lifestyle pathways wrap around)
•Our health and our offending occurs in a system
•Criminology and public health/epidemiology share some concerns in
the literature

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Health and crime is a system issue – Licensing
is a key part of the system
• Pervasive health inequalities
and poorer outcomes in
offender communities
• Multilevel issues – requires
interventions across all levels
of public health
• Partnership across new
responsibilities
• Links between health and
offending behaviour
Levels of Public Health Action
•Social
•Environmental
•Biological
•Behavioural
•Legislative
•Structural

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Domains of Response – where is the
licensing role?
Control and
Enforcement
Prevention Treatment,
Support and
Care
Licensing has a
clear enforcement
and control role
Licensing can
have a prevention
role

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Domains of Response – where is the
licensing role?
Control and
Enforcement
Prevention Treatment,
Support and
Care
Need to do better
here
Public Health
NHS
Social Care
Third Sector
Brief Interventions

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Some issues to think through
• Can we adopt the Suffolk model of voluntary
high alcohol controls?
• Can we use licensing more effectively within the
law as a public health tool?

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• Jim.mcmanus@hertfordshire.gov.uk

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Alcohol, Licensing, Health and
Harm
Dawn Morrish
Health Improvement Manager,
Community Safety and Offender Health,
Dawn.Morrish@hertfordshire.gov.uk

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Public Health and Licensing
• The Director of Public Health has a statutory
obligation, Public Health being a Responsible
Authority
• We receive copies of all new licence
applications, variations and licence reviews from
all 10 Local Authorities
• Public Health can present health-related
evidence to licensing committees
• Contribute evidence to support licence reviews

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Public Health evidence
• ‘Cardiff model’- sharing of non-confidential data
from A&E departments on assaults associated
with alcohol
• Core information: date, time, location and type
of assault, weapon used
• Sharing this information with Community Safety
Partnerships
• Enables more effective targeting of problematic
premises and aims to reduce alcohol related
burden on A&Es

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Sample of monthly raw data

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Other sources of health evidence
• Health profiles
• Local alcohol profiles
• Alcohol related hospital admissions
• liver disease mortality
• Local information of areas of high vulnerability eg
homeless hostels

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Alcohol-related Crime
2011-12 645
2010-11 787
2009-10 856
2011-12 – East Herts ranked 3rd highest in the county
for alcohol-related crime
5,488
6,022
6,866
East Herts Hertfordshire

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Violent Crime – East Herts 2012/13

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Night time violent crime
All violent crime between 9pm & 5am
2011/12
2010/11
2009/10
539
669
649
2011-12 – East Herts ranked 3rd highest in the county
for night-time violent crime
4,601
4,891
5,517
East Herts Hertfordshire

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Applications by District 2012 (Apr - Dec)
10
18
4
13
15
17
2
9
13
14
Broxbourne Borough Council
Dacorum Borough Council
East Herts District Council
Hertsmere Borough Council
North Herts District Council
St Albans City & District
Council
Stevenage Borough Council
Three Rivers Borough
Council
Watford Borough Council
Welwyn Hatfield Borough
Council

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Applications by District 2013
19
24
21
13
30
36
13
6
24
19
Broxbourne Borough Council
Dacorum Borough Council
East Herts District Council
Hertsmere Borough Council
North Herts District Council
St Albans City & District
Council
Stevenage Borough Council
Three Rivers Borough
Council
Watford Borough Council
Welwyn Hatfield Borough
Council

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0
5
10
15
20
25
Broxbourne Dacorum East Herts Hertsmere North Herts St Albans Stevenage Three Rivers Watford Welwyn
Hatfield
Application for New Premise Licences
2012 (Extrapolated from 9 months of data) 2013

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0
5
10
15
20
25
Broxbourne Dacorum East Herts Hertsmere North Herts St Albans Stevenage Three Rivers Watford Welwyn
Hatfield
New applications versus Variations 2013
Application for a premises licence Application to vary a Premises Licence

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East Hertfordshire Breakdown of On trade & Off Trade
Of 21 applications received in the year 2013 the
breakdown was as follows:
On trade: 9
Off trade: 12

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Some Successes
• Evidence supplied to 3 licence reviews in
Watford
• Led to closure of a night club for 3 months and a
additional 34 clauses added to the licence
• Revocation of a shop licence
• Licence review of an on licence premises which
has subsequently closed down